Hallucinations: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
===Organic causes===
*[[Delirium]]
*[[Intracranial mass]] to occipital or temporal lobes
*[[Encephalitis]], [[limbic encephalitis]], [[anti-NMDA receptor encephalitis]]
*[[Migraine]]
*[[Seizure]]
*[[Hypocalcemia]]/[[Hypercalcemia]]
*[[Rift valley fever]]
*[[Rabies]]
*[[Syphilis]]
*[[Vitamin B7 deficiency]]
*[[Pellagra]]
*[[Dementia]]
*[[Parkinson's Disease]]
{{Hallucinogen types}}
{{Hallucinogen types}}


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{{Dissociative drugs types}}
{{Dissociative drugs types}}


===Other Organic Causes===
====Other Toxicologic Causes====
*[[Alcohol Withdrawal]]
*[[Alcohol Withdrawal]]
*[[Anticholinergic Toxicity]]
*[[Anticholinergic Toxicity]]
*[[Tricyclic (TCA) Toxicity]]
*[[Tricyclic (TCA) Toxicity]]
*[[Ertapenem]] Toxicity
*[[Synthetic cannabinoids]]
*[[Encephalitis]]
*[[Inhalant abuse]]
*[[Hypocalcemia]]/[[Hypercalcemia]]
*[[Nitrogen narcosis]]
*[[GHB withdrawal]]
*[[Hydrocarbon toxicity]]
*[[Heavy metal toxicity]]
*Multiple medications: [[montelukast]], [[doxapram]], [[hyoscyamine]], [[tizanidine]], [[peramivir]], [[amantadine]], [[rimantadine]], [[bromocriptine]], [[methylergonovine]], [[benztropine]], [[doxepin]], [[voriconazole]], [[aciclovir]], [[valacyclovir]], [[ganciclovir]], [[cimetidine]], [[penicillin G procaine]], [[clarithromycin]], [[metoclopramide]]
*[[Inhalant abuse]]
 


===Psychiatric Causes <ref>Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156</ref>===
===Psychiatric Causes <ref>Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156</ref>===
*Schizophrenia, schizo-affective Disorder
*[[Schizophrenia]], [[schizoaffective disorder]], [[schizophreniform disorder]]
*[[Dementia]]
*[[Depression]] with psychotic features
*[[Delirium]]
*[[Bipolar disorder]]
*[[Migraine]]
*[[Seizure]]
*[[Parkinson's Disease]]
*Charles Bonnet Syndrome (in the visually impaired)
*Charles Bonnet Syndrome (in the visually impaired)


==Evaluation==
==Evaluation==
*Workup should be targeted toward specific diagnosis. Cranial imaging generally only indicated for focal neurological findings or [[Headache Red Flags|headache red flags]]
*Workup should be targeted toward specific diagnosis.  
*In non-auditory hallucinations, assume organic pathology until proven otherwise.
*In non-auditory hallucinations, assume organic pathology until proven otherwise.
*New diagnosis of psychiatric disease as cause of hallucinations should generally not be made in ED without first ruling out organic pathology
*If concern for suicidal or unknown toxic ingestion:
*If concern for suicidal or unknown toxic ingestion:
**Acetaminophen level
**Acetaminophen level
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==Management==
==Management==
*Treat the underlying pathology.
*Treat the underlying pathology.
*If hallucinations distressing, can trial dose of PO [[antipsychotic]]
*In the case of alcohol withdrawal hallucinosis, no standard therapy has been established,<ref> Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655</ref> although treatment with neuroleptics (e.g. Haldol) has shown some benefit. <ref>Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548</ref> Also continue to treat the [[Alcohol Withdrawl |alcohol withdrawal]].
*In the case of alcohol withdrawal hallucinosis, no standard therapy has been established,<ref> Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655</ref> although treatment with neuroleptics (e.g. Haldol) has shown some benefit. <ref>Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548</ref> Also continue to treat the [[Alcohol Withdrawl |alcohol withdrawal]].


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*[[Alcohol withdrawal]]
*[[Alcohol withdrawal]]
*[[Hallucinogens]]
*[[Hallucinogens]]
*[[Psychosis]]


==References==
==References==

Revision as of 03:01, 3 October 2019

Background

  • The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus
  • Etiology may be from underlying psychiatric disorder or organic cause.

Clinical Features

Differential Diagnosis

Organic causes

Hallucinations

Serotonin-Like Agents

Enactogens

Dissociative Agents

Plant-based Hallucinogenics

  • Marijuana
  • Salvia
  • Absinthe
  • Isoxazole Mushrooms
  • Hawaiian baby woodrose (Argyreia nervosa)
  • Hawaiian woodrose (Merremia tuberosa)
  • Morning glory (Ipomoea violacea)
  • Olili- uqui (Rivea corymbosa)

Organic causes

Other Toxicologic Causes

Psychiatric Causes [1]

Sedative/hypnotic toxicity

Dissociative drugs

Other Toxicologic Causes


Psychiatric Causes [2]

Evaluation

  • Workup should be targeted toward specific diagnosis.
  • In non-auditory hallucinations, assume organic pathology until proven otherwise.
  • New diagnosis of psychiatric disease as cause of hallucinations should generally not be made in ED without first ruling out organic pathology
  • If concern for suicidal or unknown toxic ingestion:
    • Acetaminophen level
    • Salicylate level
    • ECG

Management

  • Treat the underlying pathology.
  • If hallucinations distressing, can trial dose of PO antipsychotic
  • In the case of alcohol withdrawal hallucinosis, no standard therapy has been established,[3] although treatment with neuroleptics (e.g. Haldol) has shown some benefit. [4] Also continue to treat the alcohol withdrawal.

See Also

References

  1. ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156
  2. ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156
  3. ↑ Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655
  4. ↑ Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548
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